Copyright in the material you requested is held by American College Of Physicians
(unless otherwise noted). This email ability is provided as a courtesy, and by using
it you agree that that you are requesting the material solely for personal, non-commercial
use, and that it is subject to ACP's Conditions of Use.
The information provided in order to email this topic will not be used to send unsolicited
email, nor will it be furnished to third parties. Please refer to
American College Of Physicians'sPrivacy
Policy for further information.

What is the problem and what is known about it so far?

Treatments containing multiple antiviral drugs have greatly improved outcomes for HIV-infected patients. Regimens that contain powerful drugs called protease inhibitors can be particularly effective. These treatments can be difficult to follow, however, because patients need to take many pills several times a day. “Adherence ” is a term that means how often the patient takes a particular treatment as prescribed. Adherence to anti-HIV treatment is important because missing doses may let the virus multiply and can lead to poor outcomes.

Why did the researchers do this particular study?

To find out more about how adherence to protease inhibitor treatment is related to laboratory test results and outcomes in persons with HIV infection.

Who was studied?

Ninety-nine HIV-infected persons who received care at a Veterans Affairs Medical Center and a university hospital. All patients were prescribed medication regimens that included a protease inhibitor.

How was the study done?

Using special computerized caps that record the date and time whenever someone opens the medication bottle, the researchers measured how often patients took the protease inhibitor as prescribed. Over a follow-up period of 3 to 15 months, the researchers also collected information on patient characteristics; the number of HIV-related infections, hospitalizations, and deaths; and CD4 counts and viral loads (laboratory tests that measure the activity of HIV infection). When anti-HIV medicines are working, they increase the CD4 count and decrease the viral load.

What did the researchers find?

Eighty-one of the 99 patients completed the study. The viral load test indicated that the medicines were not working effectively in 22% of patients who took 95% or more of the protease inhibitor doses, 61% of those who took 80% to 95% of the doses, and 80% in those who took less than 80% of the doses as prescribed. Patients who took 95% or more of the doses as prescribed had fewer days in the hospital, HIV-related infections, and deaths than did patients who took protease inhibitors less often.

What were the limitations of the study?

This study included a small number of patients, and the findings may not apply equally to all HIV-infected patients. The researchers collected information about adherence to only one type of medicine, but the patients were taking many other anti-HIV medicines as well. Although computerized bottle caps are generally a good way to measure adherence, patients can open the bottle and not actually take the pills; they can also open the bottle once and remove several doses to take later.

What are the implications of the study?

Taking 95% or more of protease inhibitor doses as prescribed appears to be related to favorable outcomes for patients with HIV infection. However, improved strategies are needed to help patients take anti-HIV medications as prescribed.

Summaries for Patients are a service provided by Annals to help patients better understand the complicated and often mystifying language of modern medicine.

Summaries for Patients are presented for informational purposes only. These summaries are not a substitute for advice from your own medical provider. If you have questions about this material, or need medical advice about your own health or situation, please contact your physician. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the American College of Physicians-American Society of Internal Medicine.

The summary below is from the full report titled “Adherence to Protease Inhibitor Therapy and Outcomes in Patients with HIV Infection.” It is in the 4 July 2000 issue of Annals of Internal Medicine (volume 133, pages 21-30). The authors are D.L. Paterson, S. Swindells, J. Mohr, M. Brester, E.N. Vergis, C. Squier, M.M. Wagener, and N. Singh.

Summaries for Patients are a service provided by Annals to help patients better understand the complicated and often mystifying language of modern medicine.

Summaries for Patients are presented for informational purposes only. These summaries are not a substitute for advice from your own medical provider. If you have questions about this material, or need medical advice about your own health or situation, please contact your physician. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the American College of Physicians-American Society of Internal Medicine.

The summary below is from the full report titled “Adherence to Protease Inhibitor Therapy and Outcomes in Patients with HIV Infection.” It is in the 4 July 2000 issue of Annals of Internal Medicine (volume 133, pages 21-30). The authors are D.L. Paterson, S. Swindells, J. Mohr, M. Brester, E.N. Vergis, C. Squier, M.M. Wagener, and N. Singh.

Comments

Please read the other comments before posting. Contributors must reveal any conflict
of interest.
Comments are moderated and will appear on the site at the discretion of The American
College of Physicians editorial staff. Please be sure your email address is
updated in your account, otherwise the American College of Physicians will not be
able to contact you about your comment.

* = Required Field

Comment Author(s)* (if multiple authors,
separate names by comma)

Example: John Doe

Affiliation & Institution*

Disclosure of Any Conflicts of Interest*
(applies to the past 5 years and foreseeable future) Indicate any potential conflicts
of interest of each author below, including specific financial interests and relationships
and affiliations relevant to the subject matter or materials discussed in the manuscript
(eg, employment/affiliation, grants or funding, consultancies, honoraria, speakers
bureau, stock ownership or options, expert testimony, royalties, donation of medical
equipment, or patents filed, received, or pending). If all authors have none, check
"No potential conflicts or relevant financial interests" in the box below. Please
also indicate any funding received in support of this work. The information will
be posted with your response.

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College
of Physicians (ACP). All text, graphics, trademarks, and other intellectual property
incorporated into the slide sets remain the sole and exclusive property of the ACP.
The slide sets may be used only by the person who downloads or purchases them and
only for the purpose of presenting them during not-for-profit educational activities.
Users may incorporate the entire slide set or selected individual slides into their
own teaching presentations but may not alter the content of the slides in any way
or remove the ACP copyright notice. Users may make print copies for use as hand-outs
for the audience the user is personally addressing but may not otherwise reproduce
or distribute the slides by any means or media, including but not limited to sending
them as e-mail attachments, posting them on Internet or Intranet sites, publishing
them in meeting proceedings, or making them available for sale or distribution in
any unauthorized form, without the express written permission of the ACP. Unauthorized
use of the In the Clinic slide sets will constitute copyright infringement.